Heuer M, Alesina P F, Hinrichs J, Hofmeister S, Meier B, Walz M K
Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistr. 92, 45136, Essen, Deutschland,
Chirurg. 2015 Jul;86(7):676-81. doi: 10.1007/s00104-014-2787-x.
Since the introduction of minimally invasive surgery its use in liver resections is controversial. The importance of laparoscopic liver surgery within a large collective has been studied insufficiently to date.
In this article we report our experiences with minimally invasive liver resections.
A retrospective analysis was conducted looking at all patients in our clinic where a laparoscopic liver resection was performed between 01 January 2000 and 30 April 2013.
In total, we performed 94 laparoscopic liver resections in 90 patients (female n = 44, 46.8 %, male n = 50, 53.2 %) with 28 primary and 63 secondary liver tumors and 3 tumors remaining unclear. Of these 62 were atypical or wedge resections, 19 segmental resections, 8, left lateral and 3 right lateral resections as well as 1 hemihepatectomy left and 1 right. Switching to an open resection intraoperatively was necessary in eight cases. Postoperative complications were observed in two patients, one patient experienced a postoperative cerebral artery stroke and one patient died on postoperative day 13 from sepsis in multiorgan failure. The average operative time was 145 ± 82.34 min (range 10-430 min) and the average hospital stay 7 days. In 79 patients an R0 resection was achieved.
Laparoscopic liver resection can be considered a safe procedure for the treatment of liver tumors. The accurate selection of patients and appropriate expertise of the attending team in minimally invasive surgery are essential to the outcome.
自微创手术引入以来，其在肝切除术中的应用一直存在争议。迄今为止，对于大量病例中腹腔镜肝手术的重要性研究尚不充分。
在本文中，我们报告了我们在微创肝切除术中的经验。
对2000年1月1日至2013年4月30日期间在我们诊所接受腹腔镜肝切除术的所有患者进行回顾性分析。
我们共对90例患者（女性44例，占46.8%；男性50例，占53.2%）实施了94例腹腔镜肝切除术，其中原发性肝肿瘤28例，继发性肝肿瘤63例，3例肿瘤性质不明。其中，62例为非典型或楔形切除术，19例为节段性切除术，8例为左外侧叶切除术，3例为右外侧叶切除术，以及1例左半肝切除术和1例右半肝切除术。8例患者术中转为开腹手术。2例患者出现术后并发症，1例患者术后发生脑动脉卒中，1例患者术后第13天因多器官功能衰竭并发败血症死亡。平均手术时间为145±82.34分钟（范围10 - 430分钟），平均住院时间为7天。79例患者实现了R0切除。
腹腔镜肝切除术可被认为是一种治疗肝肿瘤的安全手术。准确选择患者以及手术团队在微创手术方面的适当专业技能对手术结果至关重要。
